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Post by kellyds on Mar 25, 2005 23:14:54 GMT -5
The cardiologist examined Joshua again yesterday and he said to plan on having his VSD repaired in four or five months. Our health insurance (preferred provider organization) will only pay 60% of the expense. That leaves a lot for us, especially with what we just paid off for his birth, etc.
Our income is too high to qualify for Medicaid. Our state eliminated its medically needy program a little over a year ago. Is there anywhere else I can look for assistance in paying our medical bills?
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Post by christie on Mar 25, 2005 23:32:36 GMT -5
Here in New Jersey we have DDD which has a voucher type thing that helps pay for extreme medical bills. What area are you from?? CC  |
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Post by kellyds on Mar 26, 2005 0:31:18 GMT -5
Oregon.
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Post by Valerie on Mar 26, 2005 0:57:16 GMT -5
I think we have something similar to what CC was talking about. Maybe try going to the Dept of Human Services and seeing what they may have available??  We were lucky with our insurance. Nicholas had a PA banding at 3 mos, then just had his AV canal repair this past Jan. Our total out of pocket is $1500.00, then it covers 100% for the rest of the year. Not bad, since the total we've reached so far from this last surgery is over $103,000! We've said many times these past couple years how thankful we are for this insurance!!! |
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Post by Betty & Ian's Mom on Mar 26, 2005 1:12:05 GMT -5
We had PPO when Betty had her heart surgery, over $50,000.00 we only paid the deductable of 90% I think of the bill which out of pocket was $250.00. Now we have HMO which covers 100% . Did you check out Social Security, I know in Illinois that DH makes to much for Betty to qualifiy or check out Kid Care to.
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Post by Pat on Mar 26, 2005 8:28:45 GMT -5
Kelly, Here in PA we have medical assistance, just because John-John has DS. Your income does not matter. I could be a millionaire  First it comes out of our medical ins, then the rest comes out of MA. I do not even pay the co-pay. You need check what your state has. Pat |
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Post by justinsmom on Mar 26, 2005 16:27:24 GMT -5
Here in Michigan, Justin qualified for KidsCare through the Congenital Heart Clinic at U of M ( he had/has ASD/VSD). My niece non DS was automatically covered through Medicaid because of ASD at age 3 months she is 11 now and is still qualified because of it and the possibility of another surgery in 2 yrs. and the coverage will continue til she's 18 and it has no bearing on income. DH has PPOM and that is Justin's secondary along with Medicaid and Children's Special Health. Have you tried to ask the Hospital Social Worker what types of programs are available in your area for children with Special Needs.
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Post by Sherri on Mar 26, 2005 16:40:55 GMT -5
Hi Kelly,
We don't qualify for any medical assistance & have private pay insurance. So we had to set up a payment plan for our portion. Jared has had 8 surgeries total & our health insurance has gone up something terrible. We now have to pay $2,200.00 every quarter for me & my 2 boys. I've tried to shop around & can't find any one that will cover Jared. I don't know what we'll do if they ever cancel us. We've had this insurance for almost 8 yrs now.
I wish you guys all the best with Joshua's up coming surgery. Jared had open heart (Intermediate AV Canal, Secundum ASD & PDA) at 9 months of age & came through with flying colors.
Have great day!!
Sherri
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Post by MB on Mar 26, 2005 20:56:09 GMT -5
Who said your insurance will only pay 60% of a major heart surgery? I am wondering if this is your first inquiry and the insurance company is hoping you will go looking somewhere else for help.
Why would major coverage only cover 60% of a major medical condition? This is why I think you may be getting the run around from the insurance company. If the insurance is through work, i would go to the person in charge of benefits and talk to them. If it is 60% because you have to satisfy a large deductible, then it does make sense.
When our son was younger, we were routinely denied coverage. The Insurance company ended up covering everything including therapies. I did not give up until I had the Medical Director on the phone.
I would also try the regional children's hospital for help and maybe the American Heart Association. You might ask the office manager at the Cardiologist's office if he/she knows of any foundations that help with these expenses.
In our city, we have a foundation funded by a wealthy family that offers any hearing device free of charge to children under the age of three. There are no income guidelines.
Maybe you have something like that in your area.
Best of luck!
MB
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Post by kellyds on Mar 26, 2005 23:11:35 GMT -5
It's a preferred provider coverage. It pays 100% of services from their preferred providers (local doctors . . . no cardiologists). It only pays 60% for out-of-area services.  |
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Post by YoshsMom on Mar 27, 2005 10:21:17 GMT -5
NJ also has the Catastrophic Illness in Children Fund which covers all medical expenses over 10% of your income. Some hospitals have charity care. Talk to Joshua's service coordinator or case manger and ask the financial dept at the hospital. I'm still filling out forms for Yosh's last surgery and that was a year ago.
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Post by MB on Mar 27, 2005 16:05:00 GMT -5
Kelly,
I am sorry to be such a nudge, but just because the cardiologist is not listed in their brochure does not mean he is not a provider.
Has someone IN AUTHORITY at your insurance company or your benefits coordinator at work told you that you are responsible for 40% of this huge bill? Again, I apologize but having 13 years into Ds and insurance companies, something smells fishy here.
By IN AUTHORITY, I mean....... Ask the person on the phone if they have the authority to authorize this coverage, if the answer is no, you need to talk to someone IN AUTHORITY. You need the someone who can authorize the coverage. You just keep calling and sending registered letters recapping every phone call with a first and last name of every person to whom you have spoken. Keep copies of the registered letters and of course a journal of all phone calls.
You have nothing to lose!
God bless and good luck!
MB
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Post by TriciaF on Mar 27, 2005 18:06:59 GMT -5
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Post by Debi on Mar 27, 2005 19:59:58 GMT -5
All states also participate in CHIPS the supplemental health care for all children in a state. Your state may have a different name ( Iowa calls it HAWK-I) but it works like this:
Depending on your income your child is covered for l00% under a CHIPS program. You may have to co pay an amount depending on family income but I think the limit is something like $50.00 a month. It does depend on family income but you can make rather a lot (lots more than you make for medicaid ) and stilll qualify. If your children income qualify pre-existing conditions are not a problem. Call or viist your state dept of health's website for details.
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Post by Ashlea on Mar 29, 2005 7:50:11 GMT -5
Chandler had AV Canal repair @ 3 months. We had the same issue with preferred providers, but since there were only 3 pediatric cardiologists in Alabama and only a hand full of surgeons in the nation that could perform his surgery, it was covered at 100%. In our provider directory, there were no "listed" pediatric surgeons, but was covered because it was medically necessary.
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First it comes out of our medical ins, then the rest comes out of MA. I do not even pay the co-pay. You need check what your state has.
jackie
